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Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients.
J Thromb Thrombolysis. 2020 Oct; 50(3):580-586.JT

Abstract

The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients.

Authors+Show Affiliations

Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.Department of Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China.Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China. litsh@263.net.Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1# Shuai Fu Yuan, Beijing, 100730, China. zhutn@pumch.cn.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32648093

Citation

Zhang, Yan, et al. "Profile of Natural Anticoagulant, Coagulant Factor and Anti-phospholipid Antibody in Critically Ill COVID-19 Patients." Journal of Thrombosis and Thrombolysis, vol. 50, no. 3, 2020, pp. 580-586.
Zhang Y, Cao W, Jiang W, et al. Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients. J Thromb Thrombolysis. 2020;50(3):580-586.
Zhang, Y., Cao, W., Jiang, W., Xiao, M., Li, Y., Tang, N., Liu, Z., Yan, X., Zhao, Y., Li, T., & Zhu, T. (2020). Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients. Journal of Thrombosis and Thrombolysis, 50(3), 580-586. https://doi.org/10.1007/s11239-020-02182-9
Zhang Y, et al. Profile of Natural Anticoagulant, Coagulant Factor and Anti-phospholipid Antibody in Critically Ill COVID-19 Patients. J Thromb Thrombolysis. 2020;50(3):580-586. PubMed PMID: 32648093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Profile of natural anticoagulant, coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients. AU - Zhang,Yan, AU - Cao,Wei, AU - Jiang,Wei, AU - Xiao,Meng, AU - Li,Yongzhe, AU - Tang,Ning, AU - Liu,Zhengyin, AU - Yan,Xiaowei, AU - Zhao,Yongqiang, AU - Li,Taisheng, AU - Zhu,Tienan, PY - 2020/7/11/pubmed PY - 2020/10/2/medline PY - 2020/7/11/entrez KW - Antiphospholipid antibody KW - COVID-19 KW - Coagulopathy KW - Critical KW - Factor VIII SP - 580 EP - 586 JF - Journal of thrombosis and thrombolysis JO - J Thromb Thrombolysis VL - 50 IS - 3 N2 - The outbreak of novel coronavirus disease 2019 (COVID-19) has now become a global pandemic. Coagulopathy has been reported widely in critically ill COVID-19 patients and was related to high mortality. However, the comprehensive coagulation profiles have not been examined and the underlying mechanism of the coagulopathy in COVID-19 patients is unclear. To study the coagulation profiles of routine hemostasis tests, natural anticoagulants, coagulant factors and antiphospholipid antibodies in critically ill COVID-19 patients. This single-center and cross-section study included 19 patients with COVID-19, who were admitted to intensive care unit (ICU) at Tongji hospital in Wuhan, China, from Feb 23 to Mar 3, 2020. Demographic data, laboratory parameters, treatments and clinical outcomes of the patients were collected and analyzed. The final date of follow-up was Mar 31, 2020. In this study, 12 thrombotic events occurred in 9 patients, including 4 cerebral infarctions, 7 acro-ischemia and 1 internal jugular vein thrombosis. The common abnormalities of routine coagulation tests included evelated D-Dimer level (100%), prolonged prothrombin time (73.7%) and hyperfibrinogenemia (73.7%). The median activities of natural anticoagulants including protein C, protein S and antithrombin were all below the normal range. Factor VIII activities were significantly above normal range (median value 307%, IQR 198-441) in all patients. Factor V and factor VII activities were significantly lower in near-terminal stage patients. Anti-phospholipid antibodies were present in 10 patients. Strikingly, 4 cerebral infarction events were in patients had anti-phospholipid antibodies of multiple isotypes. Sustained hypercoagulable status and thrombotic events were common in critically ill patients with COVID-19. The low activities of natural anticoagulants, elevated factor VIII level and the presence of antiphospholipid antibodies, together, may contribute to the etiopathology of coagulopathy in COVID-19 patients. SN - 1573-742X UR - https://www.unboundmedicine.com/medline/citation/32648093/Profile_of_natural_anticoagulant_coagulant_factor_and_anti_phospholipid_antibody_in_critically_ill_COVID_19_patients_ L2 - https://doi.org/10.1007/s11239-020-02182-9 DB - PRIME DP - Unbound Medicine ER -